P4420Differential impact of cigarette smoking on in-hospital mortality in women compared with men among patients with acute myocardial infarction

Background: Cigarette smoking is an important risk factor for worse outcomes in patients with coronary artery disease. Whether smoking confers the same excess risk for women versus men is not known. Therefore, we sought to investigate the effect of cigarette smoking on clinical outcomes in women versus men with acute myocardial infarction after adjusting for other risk factors. Methods: We prospectively evaluated a total of 10,516 patients with acute myocardial infarction between January, 2013 and June, 2015 in our cardiovascular center. All the patients were stratified according to smoking status and sex. The impact of cigarette smoking on in-hospital mortality and the interaction between the effect of smoking on death and sex were evaluated by Logistic regression model. Results: Among 6,531 men and 3,985 women with AMI, the prevalence of cigarette smoking was 42.5% (n=2776) and 10.4% (n=415) respectively at admission (p<0.001). The women were older (75.6±10.8 vs 68.3±11.6 years, p<0.001) and had a higher prevalence of hypertension, hyperlipidemia, and heart failure compared with men. Smokers have higher in-hospital mortality in both men (3.8% vs. 2.4%, p<0.001) and women (5.2% vs. 1.9%, p<0.001). After adjusting for baseline characteristics, smoking was an independent predictor of in-hospital mortality in both men and women but had stronger impact among women versus men (For women, odds ratio [OR] 2.82, 95% CI 1.43 to 5.56; p=0.011; for men, OR 1.62, 95% CI 1.03 to 2.54, p=0.024; interaction p value = 0.016).